I've been picking up things here and there on this forum and I have a question on reflexes. In my husbands first exam with Neurologist, the Dr. notes that "Reflexes are A+ with the exception of left ankle jerk, which is absent." Then when we went for exam with 2nd opinion Dr. he said he wanted an MRI on his upper spine because although it wouldn't explain the foot drop it might account for the "Brisk reflexes". Both exams show toes downgoing with the Babinski test. Can someone clear up what this might mean. I read here somewhere that reflexes are brisk in ALS and absent in neuropathy. Can you have both. Or is ALS just a form of neuropathy? I'm confused.

I'm not a doctor but I've done some research on this. This gets a little complicated.

In ALS there is a slow dying of both the "Upper Motor Neurons" (UMN) and "Lower Motor Neurons" (LMN). ALS is different in different people. In some cases UMN are the first to go, in others it's the LMN. To make a "clinically definite" diagnosis of ALS, the neurologist must detect both UMN and LMN symptoms in a few regions. This doesn't happen until the disease has progressed pretty far.

Your doctor was looking at reflexes because heighened or "brisk" reflexes are one of the main symptoms of UMN deterioration. Sometimes LMN shows a decreased reflex, but a more common symptom of LMN is muscle weakening and wasting.

Bottom line is, it doesn't tell you much by itself, but has to be understood within the context of all the other symptoms that the doctor is looking for.

Thanks, it does get confusing. So let me see if I get this right. If my husband has atrophy in his left leg and an absent left ankle reflex, that might indicate some LMN issues. The brisk reflexes might indicate some UMN issues. The downgoing Babinski is a good sign though.

I just re-read your original post and I may have mis-lead you if you interpret "brisk" and "normal" reflexes as the same thing. The UMN symptom is actually heightened or exaggerated reflexes. This is what I thought you meant by "brisk" but now I'm not so sure since you also say "A+". If Steve has normal reflexes I would think this is a good sign also, not an indicator of any UMN decay.